KidsPeace believes that it is helpful to our readers to reprint some Healing Magazine articles that are as relevant today as when they were published in our Magazine. This article discusses how communication is so important when doctors prescribe psychotropic medications to children. This article was published in the Spring/Summer 2006 issue.

Children’s Psychotropic
Medications: Communication is key

By Pat Sullivan

Millions of children take
prescription psychotropic medications to treat a wide range of conditions that
can destroy their quality of life. According to Dr. Adnan B. Zawawi,
Psychiatrist at KidsPeace Psychiatric Hospital, it is imperative that parents
and physicians establish open communication early in a child’s treatment. “At
KidsPeace, we provide parents with written information on any medications we
might prescribe in the admissions packet so that parents can make informed
decisions regarding their children’s treatment. They must give us written
consent before we start any medication,” Zawawi says. He also wants to dispel a
common myth: “These are not drugs; they are medications. Just as we prescribe
medications for hypertension, diabetes or infections, we prescribe medications
for illnesses of the mind.”

There are several classes of
psychotropic medications that are typically prescribed for youth:

Antidepressants

• Tricyclics – Older drugs.
These medications (some brand names include Adapin, Elavil, Pamelor and
Tofranil) are typically only used when SSRIs (see below) are ineffective.

• SSRIs (Selective Serotonin
Reuptake Inhibitors) – Newer antidepressants (some brand names include Prozac,
Zoloft, Paxil and Lexapro) used more commonly because they restore deficits in
certain neurotransmitters that facilitate communication between brain cells
(neurons) and return the brain to normal functioning with few side effects.

Dr. Zawawi emphasizes that
depression is a serious medical problem that causes the brain to function
differently from those of individuals who are not depressed. The benefits of
taking antidepressants far outweigh the risks associated with them. Dr. Zawawi
also notes that NIH studies have shown that patients treated with a combination
of SSRIs and therapy had higher success rates than those taking SSRIs alone or
those undergoing therapy alone.

Typically, antidepressants
are used for a year or two, with cessation being gradual and closely supervised
by a physician. One should never abruptly stop antidepressants. Dr. Zawawi
emphasizes that starting a child on an antidepressant or other psychotropic
medication is a major decision that is based on improving the child’s quality
of life, happiness and productivity.

Mood Stabilizers

• Lithium – A salt that has
been used since the 1970s to treat bipolar disorder, particularly manic
episodes; depression while on Lithium may indicate that a higher dosage is
needed. It is important to monitor levels of Lithium (some brand names include:
Cibalith-S, Eskalith, Lithane, Lithobid, Lithonate and Lithotabs) in the blood
stream and to consult with prescribing doctors before taking any medications, including,
but not limited to, ibuprofen, antihypertensives, muscle relaxers and
diuretics.

• Anticonvulsants – Helpful
in controlling mood swings, although their main use is to prevent seizures
(some brand names include Depakote, Topamax, Tegetrol, Lamictal and
Clonazepam).

• Atypical Antipsychotics –
Used alone or in combination with mood stabilizers can be quite effective,
although it is very important to use as directed (brands include Abilify,
Navene, Risperdal, Seroquel).

Bipolar disorders in adults
are marked by wide-ranging mood swings from deep depression to unbridled mania,
but, according to Dr. Zawawi, children experience fewer “top of the world”
highs and deep troughs. Instead, bipolar children are typically irritable,
cranky and miserable, with sometimes explosive mood swings that can result in
unhappiness, difficulty in school and trouble with the law. “Mood disorders
require medication,” Zawawi says. “Lithium is the standard and has been used
for a long time, but the atypicals are gaining popularity. All mood stabilizers
must be used as directed.”

Antipsychotics

• Antipsychotics – Older
medications that effectively reduce symptoms of psychosis but can have severe
side effects and do not control mood swings (some brands include: Thorazin,
Mellaril, Haldol and Prolixin.)

Psychosis and schizophrenia
are serious conditions that cause people to experience visual and auditory
hallucinations and delusions. The side effects of some antipyschotics can be
very serious, but schizophrenic patients need to take them long term in order
to function within society. The two most serious types of side effects, although
rare, include: (1) extraperonial symptoms such as rigidity, stiffness, tremors
and tardive dyskinesia, which is uncontrollable movement of the mouth, arms and
other body parts, and (2) metabolic disorders such as diabetes, high
cholesterol and weight gain. Therefore, Dr. Zawawi warns that anyone taking
antipsychotics have regular blood sugar, lipid and liver function tests, as
well as family history screening and close supervision. Zawawi stresses that
doctors are very careful about putting children on these medications and try to
use antipsychotics for as short a time period as possible.

Psychostimulants

Psychostimulants are used in
the treatment of Attention Deficit Disorder (ADD) and Attention Deficit
Hyperactivity Disorder (ADHD) and have been the standard for many years. Zawawi
explains that these medications are not addictive and can be used into
adulthood to help patients focus and control impulsivity. Although classified
as stimulants, these medications (including Ritalin, Concerta and Adderal) have
a calming effect on patients who suffer from ADD/ADHD. Side effects may include
sleep problems and weight loss, but psychostimulants help children perform
better in school, engage in less impulsive behavior, focus on tasks, have more
positive social experiences and generally stay out of trouble. Zawawi says that
dosage and symptoms should be closely monitored and appropriately adjusted.

Anxiolytics

Many children suffer from
extreme anxiety and school phobia, which can incapacitate them socially and academically.
Medications that treat anxiety are used short term for acute panic attacks
because they can be addictive. Anxiety disorders are more frequently treated
with SSRIs and therapy, but anxiolytics such as Xanax, Librium, Atavan and
Valium can help children through especially difficult periods. Zawawi warns
that use of these medications must be closely monitored and carefully tapered
off in terms of dosage to prevent withdrawal symptoms.

Communication

Dr. Zawawi stresses that
parents must communicate with all of the physicians who treat their children
regarding prescription and over-the-counter (OTC) medications. “Parents think
that they are bothering their doctor with calls to see if it is safe to give
decongestants or cough syrup or even pain and fever relievers to their
children, but, believe me, we would rather answer your question beforehand than
have to treat serious side effects after the fact,” he says. Combining
psychotropic medications with others medicines can cause serious and even life-threatening
reactions. “Be sure to tell your family physician about any psychotropic
medications your child is taking and encourage them to contact the psychiatrist
if there are any questions,” Zawawi says. Many psychiatrists monitor a child’s
psychotropic medications for a few months and then turn administration over to
the family physician, who is more familiar with the child’s history.

In general, antibiotics and
asthma medications are safe when taken in conjunction with psychotropics,
Zawawi explains, but it is still important to report all new prescriptions to
all of your child’s doctors. Steroids and birth control pills can cause serious
medication interactions with some psychotropics, as can fever reducers and
decongestants.

Many parents do not realize
that herbal and natural supplements can cause severe interactions with
psychotropics as well. Dr. Zawawi tells parents that he respects their
decisions if they want to try the natural route to treat their children, but
herbals should not be taken in combination with any of the psychotropics. Also,
parents should not administer larger doses than suggested by the manufacturer
of natural or herbal remedies to their children. The adage, “if a little’s
good, a lot’s much better” does not apply to natural or herbal supplements.

When it comes to alcohol and
street drugs, Zawawi is very clear with his patients. He tells them if they
combine alcohol and street drugs with their prescribed medications, they can
suffer extreme sedation, excessive irritability, seizures or comas. It can
truly be a lethal combination.

School

It can be difficult to make
a decision to inform teachers, counselors and school nurses that a child is
taking psychotropic medications. There are several points to keep in mind:

• Most schools do not allow
children to carry and take medications of any kind in school. If your child
needs mid-day administration, this has to be done by the school nurse, and the
medications must be kept under lock and key in the nurse’s office.

• Teachers often spend more
waking hours with your child than you do. If they know what your child is
taking and the possible side effects or reactions, they can watch for anything
out of the ordinary and report to you and the school nurse.

• Investigate
confidentiality issues in your school system to increase your comfort level.
Having an illness does not mean that your child will be “labeled” or suffer
discrimination of any kind. There are laws that protect against this.

• Teachers can make
adaptations to accommodate your child’s condition, including reduced homework,
tutoring, modified tests, frequent visits to the nurse or rest room, the need
to eat more frequently, rest periods in the nurse’s office if overly tired,
reduced physical activity, not going outside, etc.

• Often, teachers or school
counselors were the first to pick up on your child’s condition and referred him
or her for an evaluation in the first place. They are trained to recognize
possible problems.

• Teachers can arrange for
your child to have a quiet place to go during over-stimulating activities, gym
or even lunchtime.

• Your child may be more
comfortable knowing that the teacher, nurse or counselor understands what he or
she is going through and is approachable if the child does not feel well.

• Teachers can “run
interference” if your child is struggling with a social or academic issue and
make the situation less stressful.

• Your child may be eligible
for placement in a smaller class that better meets his or her needs on a short-
or long-term basis.

Involvement

Dr. Zawawi stresses the
importance of parents being as involved as possible in their children’s
treatment, medication, school life and healing. Acknowledging that parents are
very busy and often do not have a great deal of time to spend with their children,
he says that, at the very least, parents must:

• Monitor and administer
their children’s medications

• Communicate regularly with
all professionals involved in their children’s treatment

• Spend time with their
children to observe and discuss how they are feeling, progressing, regressing,
reacting to medication and getting along in school and socially